<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
    pageEncoding="ISO-8859-1"%>
    <%@taglib uri="http://www.springframework.org/tags/form" prefix="form"%>
<jsp:include page="header.jsp">
	<jsp:param name="pageTitle" value="Applicant Form"/>
</jsp:include>
<BR>
<table class = "roundBoarders" width = "100%">
<tr>
<td width="3%"></td>
<td>
<form:form modelAttribute="client" method="post" action="ApplInfo.html">
<td width="24%">
<H1>Enter Client: </H1>
<table class="roundBoarders">
    <tr> 
    	<td width="3%"></td>
    	<td colspan="2"><STRONG>Client Personal Info: </STRONG> <hr></td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td width="30%"><form:label path="firstname">First Name</form:label></td>
        <td><form:input path="firstname" /></td>
		<td><form:errors path="firstname" cssClass="error"></form:errors></td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td><form:label path="lastname">Last Name</form:label></td>
        <td><form:input path="lastname" /></td>
        <td><form:errors path="lastname" cssClass="error"></form:errors></td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td><form:label path="birthdate">Birthdate</form:label></td>
        <td><form:input path="birthdate" /></td>
        <td><form:errors path="birthdate" cssClass="error"></form:errors></td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td><form:label path="street">Street</form:label></td>
        <td><form:input path="street" /></td>
        <td><form:errors path="street" cssClass="error"></form:errors></td>
    </tr>
    <tr>
    	<td width="3%"></td>
    	<td>City</td>
       <td><form:select path="city">
					   <form:options items="${cityList}" itemValue="key" itemLabel="value" />
					</form:select></td>
				<td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td><form:label path="zip">Zip</form:label></td>
        <td><form:input path="zip" /></td>
        <td><form:errors path="zip" cssClass="error"></form:errors></td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td><form:label path="numOfChildren"># Of Children</form:label></td>
        <td><form:input path="numOfChildren" /></td>
        <td><form:errors path="numOfChildren" cssClass="error"></form:errors></td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td><form:label path="disabled">Disabled</form:label></td>
        <td><form:checkbox path="disabled" /></td>
    </tr>
    <tr>
    	<td width="3%"></td>
        <td><form:label path="veteran">Veteran</form:label></td>
        <td><form:checkbox path="veteran" /></td>
    </tr>
</Table>
</td>
<td width="3%"></td>
<td align="left" valign="top" width="30%">
<table style="height:60">
<tr>
<td></td>
</tr>
</table>
<table class = "roundBoarders">
<tr>
<td width="3%"></td>
<td colspan="2"><STRONG>Need Information: </STRONG><HR></td>
</tr>
<tr>
<td width="3%"></td>
		<td>Need Category: </td>
        <td><form:select path="needCategory">
					   <form:options items="${needCategory}" itemValue="key" itemLabel="value" />
					</form:select></td>
				<td>
</td>
</tr>
<tr>
<td width="3%"></td>
<td>Needed By Date: </td>
<td><form:input path="needDate"/></td>
<td><form:errors path="needDate" cssClass="error"></form:errors></td>
</tr>
<tr>
<td width="3%"></td>
<td>Need Description: </td>
<td><form:textarea path="needDescription" rows="14" cols="25" /></td>
<td><form:errors path="needDescription" cssClass="error"></form:errors></td>
</tr>
<td>
<tr>
<td>
</tr>
</table>
<td>
<input type="submit" value="Add Client"/>
</td>
</form:form>
</td>
</tr>
</table>
</body>
</html>
